Probiotics in the fight against necrotizing enterocolitis: a cost-effective yet underutilized strategy in neonatal care

Abstract

Necrotizing enterocolitis (NEC) remains a leading cause of gastrointestinal morbidity and mortality among preterm and very low birth weight infants. Probiotics, particularly multi-strain formulations including Bifidobacteria, Lactobacillus, and Enterococcus, have shown considerable promise in reducing the incidence and severity of NEC by modulating the neonatal gut microbiome, enhancing mucosal barrier integrity, and reducing systemic inflammation. Recent meta-analyses confirm their efficacy in lowering NEC risk and associated mortality. Nevertheless, routine use in clinical practice remains limited due to heterogeneity in neonatal intensive care unit practices, uncertainty around optimal strains, dosage, and treatment duration, and insufficient long-term safety data. Given their cost-effectiveness and strong evidence base, integrating probiotics into standard neonatal care protocols, while addressing existing research gaps, could significantly improve outcomes for this vulnerable population.

Keywords: necrotizing enterocolitis; neonatal care; preterm infants; probiotics.